Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany.
Stroke. 2012 Aug;43(8):2130-5. doi: 10.1161/STROKEAHA.112.651281. Epub 2012 May 8.
Multimodal recanalization therapy in patients with acute basilar artery occlusion provides high recanalization rates. A substantial subset of treated patients survives with only minor or moderate functional handicap. However, long-term functional outcome and quality of life in these patients have rarely been systematically analyzed.
In this monocentric retrospective study, we analyzed mortality, long-term functional outcome (modified Rankin Scale), and quality of life (36-Item Short-Form Health Survey questionnaire) in all consecutive patients who had been treated for acute basilar artery occlusion in our institution between December 2002 and December 2009.
Ninety-one patients (57 male; median age, 65 years; range, 20-89 years) were treated by multimodal recanalization therapy. This included intravenous thrombolysis (n=32) with consecutive on-demand intra-arterial therapy (n=23) or intra-arterial therapy alone (n=59). The overall recanalization rate was 89%. After a median observation time of 4.2 years (range, 0.5-7.4 years), the mortality rate was 59%. Among the 35 survivors, 26 patients (74%) had a good or moderate long-term functional outcome (modified Rankin Scale ≤3). Health-related quality of life was better than that of unselected patients with stroke. Backward stepwise logistic regression identified intravenous thrombolysis (P=0.002) and female sex (P=0.001) as predictors of favorable functional long-term outcome (modified Rankin Scale ≤3). Coma at admission (Glasgow Coma Scale ≤8) was associated with poor outcome (modified Rankin Scale ≥4; P=0.036).
Long-term survival is achieved in approximately 40% of patients with basilar artery occlusion treated with multimodal recanalization therapy. Approximately 75% of the survivors have a favorable functional long-term outcome with an acceptable quality of life.
急性基底动脉闭塞患者的多模态再通治疗可提供较高的再通率。相当一部分接受治疗的患者仅有轻微或中度的功能障碍存活下来。然而，这些患者的长期功能预后和生活质量很少被系统地分析。
在这项单中心回顾性研究中，我们分析了 2002 年 12 月至 2009 年 12 月在我院接受急性基底动脉闭塞治疗的所有连续患者的死亡率、长期功能结局（改良 Rankin 量表）和生活质量（36 项简短健康调查问卷）。
91 例患者（57 例男性；中位年龄 65 岁；范围 20-89 岁）接受了多模态再通治疗。包括静脉溶栓治疗（n=32），随后按需进行动脉内治疗（n=23）或单纯动脉内治疗（n=59）。总的再通率为 89%。中位观察时间为 4.2 年（范围 0.5-7.4 年）后，死亡率为 59%。在 35 名存活者中，26 名患者（74%）有良好或中度的长期功能结局（改良 Rankin 量表≤3）。健康相关的生活质量优于未选择的脑卒中患者。向后逐步逻辑回归确定静脉溶栓（P=0.002）和女性（P=0.001）为良好的长期功能结局（改良 Rankin 量表≤3）的预测因素。入院时昏迷（格拉斯哥昏迷量表≤8）与不良结局（改良 Rankin 量表≥4；P=0.036）相关。
多模态再通治疗可使约 40%的基底动脉闭塞患者长期存活。约 75%的幸存者有良好的长期功能结局和可接受的生活质量。
